AB0608 TIME OF DIAGNOSIS AND INITIATION OF TREATMENT OF GIANT CELL ARTERITIS (GCA) ACCORDING TO CLINICAL PHENOTYPE AND REFERRAL ORIGIN
Authors: M. López I Gómez, P. Moya, I. Castellví, H. Corominas
Journal: Annals of the Rheumatic Diseases (2022)

Background Giant cell arteritis (GCA) presents two phenotypic patterns: cranial and extracranial. Cranial manifestations are relatively easier to recognize and to diagnose, however since the extracranial are more insidious and less known, it may lead to a delay in diagnosis and in treatment. The main treatment are glucocorticoids (GC) at high doses followed by a descending pattern. The time between the begin of the symptoms and the start of the treatment with GC it’s of vital importance in the prognosis of the disease. Objectives The present AUDIT describes our cohort’s clinical features, the time from symptom onset to rheumatology visit and diagnosis of GCA, as well as the differences in time according to the service originating the referral. Methods Audit retrospective, descriptive study of patients diagnosed with GCA by the CGA 1990 criteria. All patients diagnosed with GCA from 2011 to 2021, in a single hospital center and referred to the Rheumatology Service were included. Patients were classified as: cranial phenotype, extracranial or mixed. Demographic and clinical variables and complementary examinations were collected. As well as the time from the first symptom until the patients are referred and diagnosed. Results Seventy patients were included in the study. Fifty-one patients (72.9%) were female, their clinical features are shown in Table 1. Twelve of them (17,39%) had a cranial phenotype, sixteen (23,18%) an extracranial phenotype and forty-one (60,42%) a mixed one. Extracranial phenotype patients showed to be younger at the time of the diagnoses than the other groups. Cranial phenotype patients had a lower increase of the acute phase reactants than the other phenotypes (without finding statistically significant differences). In Table 2 are shown the other demographic, clinical and analytic data. Table 1. Disease Characteristics of the Patients at Baseline according to their phenotype PHENOTYPE CRANIAL EXTRACRANIAL MIXED TOTAL N=12 N=17 N=41 N=70 Age 75.543 ± 7.48 73.543 ± 8.1 76.356 ±7.46 75.56 ±7.46 Smoker 8.3% (n=1) 11.8% (n=3) 14.6% (n=6) 12.9% (n=9) Headache 91.7% (n=11) 0% 90.2% (n=37) 68.6% (n= 48) Ocular involvement 58.3% (n=7) 0% 34.1% (n=14) 30% (n=21) Fever of unknow origin 0% 29.4% (n=5) 34.1% (n=14) 27.1% (n=19) Polymyalgia rheumatica 0% 41.2% (n=7) 53.7% (n=22) 41.4% (n=29) Constitutional syndrome 0% 23.5% (n=4) 36.6% (n=15) 27.1% (n=19) Cutaneous hyperalgesia 25% (n=3) 0% 31.7% (n=13) 22.9% (n=16) Anaemia 0% 41.2% (n=7) 46.3% (n=19) 37% (n=26) C reactive protein 51.33 ± 40.16 77.83 ± 75.30 85.55 ± 81.67 77.58 ± 74.57 Erythrocyte sedimentation rate 60.64 ± 33.13 76.20 ± 36.35 77.93 ± 35 74.65 ± 35.07 Patient referral were made from: Emergency room/ Internal Medicine hospitalization (30%, 21 patients), Primary Care (21.4%, 15 patients), Internal Medicine outpatient clinic (15.7%, 11 patients), Neurology (18.6%, 13 patients) and other specialties outpatient clinic (cardiology, vascular surgery, ophthalmology, hematology and gastroenterology). The median of the time from the first symptom until the patients are diagnosed are 12,9, 13,97 and 7,91 weeks in the cranial, extracranial and mixed respectively. The median of time from the first symptom until the patient referral to rheumatology are 9.34, 12.74 and 5.87 weeks in the cranial, extracranial and mixed respectively. The median of time from patient referral to rheumatology to be assessed are 3.73, 5.59 and 3.43 weeks in the cranial, extracranial and mixed respectively. 75.7% of the patients received treatment with glucocorticoids before being referral to rheumatology. Conclusion In our cohort, most of the patients with CGA had a mixed phenotype. The patient referral to rheumatology is made mainly from the emergency room, internal medicine hospitalization and primary care. Patients with mixed phenotype are diagnosed faster than the ones with an exclusively extracranial phenotype. The time between the first symptom and the referral to rheumatology is still long. Disclosure of Interests None declared